24 Holter Monitor Results
SVPB Prematurity 20%
Pause 2000 msec
ST Segment Depression uV (cannot make correct symbol for u)
St segment Elevation 200 uV
Long RR/pause N-N Only
Pause excluded from HR No
min rate 42 at 21:40:28
max rate 113 at 13:11:23
total QRS 102399 (?)
AFib rate (0%) / 82 bpm
fastest run 128 bpm at 12:26;08
longest run 6 at 20:32:08
R on T 0
Atrial fibrillation was detected for 0% of the monitoring period and the peak average rate during atrial fibrillation was 82.
Supraventricular ectopic activity consisted of 8427 beats, which included 5951 single beats, 1213 couplets and 15 runs of 3 beats or longer.
The fastest supraventricular run had a rate of 128 bpm and occurred at 12:26:08. The longest run was 6 beats long and occurred at 20:32:08
Ventricular ectopic activity consisted of 607 beats, which included 607 single beats.
The longest R-R interval was 1.62 sec at 07:15:38, with 0 RRs longer than 2.0 sec
My complaint of palpitations started six years ago and a 24 hour holter monitor was done at that time. Nothing showed (there were 2 VE beats, 103 SVE beats, and the longest RR 1.4 sec.) I was told that was very normal and more likely stress related palpitations. Last April, I had a terrifying experience while working in the garden. I felt as though my heart was racing a mile a minute and felt considerable pounding in my chest and on the left side of my neck. After several minutes it got better and I went in and rested. In June, I had a similar experience while briskly walking through a parking lot. In the past year, these palpitations have been happening several times a day but I have not had any more "severe" episodes. I don't know if the results of the holter show what I am feeling but I would like to know if this may all be part of some type of anxiety that I don't realize I have? I truly do not feel anxious and have always considered myself to be happy, content, and as near to stress free as a person could be.
I think it means the ectopic beat occurred close enough to the preceding beat that the electrical system in the lower chambers of the heart hadn't completely recovered so the QRS waveform of the ectopic beat is different from the usual QRS waveform. I don't think it's dangerous, but if you got your Holter results, you should have spoken to your cardiologist already. What did he say?
I hadn't heard from my primary care doctor yet, so I called his office this morning. I went to the hospital and requested my records and that is how I got this information. There was a small misunderstanding with my doctor's office. He had received the holter results from the fort hospital, from 2006, and accidentally thought those were from last week. His nurse just called and said that he will be reviewing them this afternoon.
Okay, well this turned out to be a pretty information-packed, long response, but I believe it can do a lot of good for you in understanding your situation if you go ahead and read it. I would also like to warn you that I am not a doctor. I am just a student, who happens to have a particular area of interest in the heart. Maybe someday I'll be a cardiologist or something, but I'm not one now, so take everything that I say with the knowledge that I am not a licensed doctor or anything. But anyways....
From what you wrote it sounds like you are having both PVCs and PACs, which are just premature beats. When you have a premature beat in the ventricles then it's called a PVC and if it is a premature beat in the atrium then it's a PAC. If you have more than 3 of either of these types of beats in a row then it's technically SVT (supraventricular tachycardia) or VT (ventricular tachycardia).
A-fib or V-fib is atrial or ventricular fibrillation. Fibrillation just means that the atrium or the ventricle quivers instead of actually beating. If this happens in the atrium, it's A-fib and while that wouldn't be good, A-fib itself doesn't kill you (it can't). It would just be a sign that maybe your electrical system as a whole isn't quite right. If you have V-fib you pass out within seconds and die within minutes. V-fib is what causes SCD (sudden cardiac death).
Now, you obviously didn't have V-fib (you're still alive after all) and you didn't have any A-fib show up on your Holter either. The fact that you had some runs of PACs (the SVT I talked about earlier) isn't necessarily ideal, but it's not nearly as dangerous as if you were experiencing V-tach, because SVT is just annoying and can generally be taken care of through an ablation procedure if it's just too debilitating to your state of mind (as it eventually does become for many). If you were having episodes of VT (you're not, at least not on the day of your Holter study which makes it much more likely you aren't at all) they would basically have to try to ablate it because of the potential for it to someday be happening and degenerating into V-fib.
However, V-tach isn't always easily ablated, so if someone has it and they can't take care of it in that way then they could possibly just recommend you get an ICD so that in case you ever go into an episode of V-tach the ICD paces you out of it before you degenerate into V-fib, and should you go straight into V-fib, the "D" part of the ICD is for "defibrillator" means you would get an instant shock to get your heart out of the V-fib before it kills you. The ICD's are very effective at this, which is why they save lives. The reason people die of SCD is because they go down and it then it often takes minutes to get proper help and defibrillators to them and by then it's far to late. If you get the shock right away there have been studies and such that say you would have about a 98-99% chance of being saved. That's why ICD's are so good at saving lives. They give you the shock right away and you end up living. However, this doesn't appear to be you, so I wouldn't worry too much about that.
For you, if it is just the SVT with the PACs and PVCs, then you could either just try to ignore the symptoms, get an ablation, or possibly try to alleviate symptoms with medication. However, anti-arrhythmic meds are pretty dangerous as they often do more harm than good, so if you really wanted to try to treat SVT without going through an ablation procedure (although they are 99.5% safe), then you might just talk to your doctor about an ACE inhibitor or beta blocker (the same meds they use to treat things like high blood pressure) because these help relax the heart and might, as a result, make the frequency of your symptoms go down substantially.
If you really wanted to put your mind at ease that you are only experiencing the far more benign arrhythmias that are PVCs, PACs, and SVT, and not the more dangerous V-tach that you would need to treat, then you could do one of the following two things: You could wear what's called an "event monitor" which is a Holter study that is like the one you already took, but for far longer (usually a month straight, and you take it off to shower). If you still didn't have any V-tach show up during 30 days (especially if you had symptoms during most of those days) then it becomes even less likely that you have V-tach going on.
If that isn't reassuring enough for you, you could opt for something called an EP study (electrophysiology study). An electrophyisologist, who is a specialist dealing with the electrical workings of the heart would put a catheter wire in through your groin up to your heart and then try to provoke different kinds of arrhythmias. You would be sedated but not put out for this procedure. They have the defibrillators right there just in case they induce a dangerous V-tach that could go into or even does go into V-fib. So, essentially, during the procedure you have the equivalent of the safety net that someone wearing an ICD does. It makes it incredibly unlikely that anything bad (like death) could happen to you during the study. It has zero complications about 97% of the time, and usually most of those are just minor things like if you got a little infection at the insertion spot in your groin or something. Major complications are nearly 1/4 less (less than 1% overall) than the complications associated with minor procedures like getting your tonsils out. If they can induce any kind of arrhythmia during the procedure they ablate it if they can. This is where they use heat or freezing cold to burn off the part of the electrical path that is causing the arrhythmias. This forces the path back to it's regular, normal path so you no longer have the arrhythmia. If it's an arrhythmia they can't ablate then they either recommend an ICD if it's dangerous, or just tell you they couldn't get it if it's a non-dangerous arrhythmia. It's a good thing to have done if you really just can't live with not knowing what kind of arrhythmia you have and/or the symptoms of it. However, if you can deal then the risks associated with it (albeit incredibly, incredibly small) are not worth it.
In terms of whether or not this is attributable to your anxiety I would say the following: anxiety is one of many things that can make an arrhythmia show up more often and more intensely. Other things like weight, dehydration, defeciences of certain nutrients, etc, etc can also contribute to such. The anxiety itself is not the cause of them per say, but if you just have a minor electrical issue like some PVCs and PACs, then it effectively treating your anxiety might do wonders to essentially rid nearly all of the palpitation sensations you experience.
The only other thing I would say is that actual heart problems can be another thing that make arrhythmias show up more and more frequently. So, if you have not gotten an echocardiogram done, it might be good for you to think about getting one if your doctor agrees and if your insurance covers it. An echocardiogram would just confirm that you don't have any structural heart defects that are causing a separate electrical problem to show up more frequently. I seriously doubt this is the case with you. It really sounds like you just have an electrical problem that is being made to show up more by your anxiety, but I suppose it is always better to be safe than sorry, so I thought I would let you know. There is also a simple blood test called a BNP blood test you could do along with the echo that would rule out congestive heart failure. If the BNP and the echo came back normal then you would know it's not the heart itself that is causing this stuff. Rather, it would just be strictly an arrhythmia problem that you can treat with an ablation if need be.
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